In Reply: Dr Engels and colleagues argue that
in our study of the incidence and risk factors of acquired immunodeficiency
syndrome (AIDS)–related opportunistic illnesses after the initiation
of potent antiretroviral therapy, we may have underestimated or overestimated
the effectiveness of antiretroviral therapy. Our aim was not to estimate the
effectiveness of antiretroviral combination therapy, which has been conclusively
demonstrated in randomized controlled trials1
and prospective cohort studies.2- 4
Rather, we set out to examine incidence trends and risk factors for individual
opportunistic illnesses in a stable cohort of HIV-infected adults, covering
defined periods before and immediately after starting potent therapy.